description: This profile provides minimal, non-persoanlly-identifiable content for submission in an RTPBC request to data sources that can provide benefit or price information without receiving patient details.
package_name: hl7.fhir.us.carin-rtpbc
derivation: constraint
name: RtpbcRequestClaimNonPHI
type: Claim
elements:
  patient:
    label: Patient information (masked)
    short: Patient information (masked)
    index: 10
    extensions:
      data-masked:
        url: http://hl7.org/fhir/StructureDefinition/data-absent-reason|5.2.0
        type: Extension
        mustSupport: true
        index: 12
        elements:
          value:
            pattern: {type: Code, value: masked}
            choices: []
            index: 14
    elements:
      extension:
        mustSupport: true
        index: 11
        slicing:
          slices:
            data-masked:
              match: {}
              schema:
                type: Extension
                mustSupport: true
                url: http://hl7.org/fhir/StructureDefinition/data-absent-reason|5.2.0
                index: 12
                elements:
                  value:
                    pattern: {type: Code, value: masked}
                    choices: []
                    index: 14
      reference: {index: 15}
      type: {index: 16}
      identifier: {label: 'Unique, non-personally identifiable code', short: 'Unique, non-personally identifiable code', index: 17}
      display: {index: 18}
    required: [extension]
  insurance:
    label: Patient insurance information (masked)
    short: Patient insurance information (masked)
    index: 31
    elements:
      sequence:
        pattern: {type: PositiveInt, value: 1}
        index: 32
      focal:
        pattern: {type: Boolean, value: false}
        index: 33
      coverage:
        label: Insurance Coverage Masked
        short: Insurance Coverage Masked
        index: 34
        extensions:
          data-masked:
            url: http://hl7.org/fhir/StructureDefinition/data-absent-reason|5.2.0
            type: Extension
            mustSupport: true
            index: 36
            elements:
              value:
                pattern: {type: Code, value: masked}
                choices: []
                index: 38
        elements:
          extension:
            mustSupport: true
            index: 35
            slicing:
              slices:
                data-masked:
                  match: {}
                  schema:
                    type: Extension
                    mustSupport: true
                    url: http://hl7.org/fhir/StructureDefinition/data-absent-reason|5.2.0
                    index: 36
                    elements:
                      value:
                        pattern: {type: Code, value: masked}
                        choices: []
                        index: 38
          reference: {index: 39}
          type: {index: 40}
          identifier: {index: 41}
          display: {index: 42}
        required: [extension]
  use:
    label: Processing Mode
    short: Processing Mode
    pattern: {type: Code, value: predetermination}
    mustSupport: true
    index: 9
  item:
    label: Max 1 item per request
    short: Max 1 item per request
    mustSupport: true
    index: 43
    elements:
      sequence:
        mustSupport: true
        pattern: {type: PositiveInt, value: 1}
        index: 44
      careTeamSequence: {index: 45}
      productOrService:
        label: Prescribed Product
        short: Prescribed Product
        binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/us/carin-rtpbc/ValueSet/rtpbc-prescribable-product-code'}
        mustSupport: true
        index: 46
        elements:
          coding:
            mustSupport: true
            index: 47
            elements:
              system: {mustSupport: true, index: 48}
              code: {mustSupport: true, index: 49}
              display: {label: Product Description, short: Product Description, mustSupport: true, index: 50}
          text: {mustSupport: true, index: 51}
      quantity:
        label: Prescribed Quantity
        short: Prescribed Quantity
        mustSupport: true
        index: 52
        elements:
          value: {label: Quantity in Billing Units, short: Quantity in Billing Units, mustSupport: true, index: 53}
          unit:
            label: Billing unit of measure
            short: Billing unit of measure
            binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/us/carin-rtpbc/ValueSet/rtpbc-billing-unit'}
            mustSupport: true
            index: 54
        required: [value, unit]
    required: [quantity]
  type:
    label: Requested Service Type
    short: Requested Service Type
    mustSupport: true
    index: 4
    elements:
      coding:
        mustSupport: true
        index: 5
        elements:
          system:
            pattern: {type: Uri, value: 'http://terminology.hl7.org/CodeSystem/claim-type'}
            mustSupport: true
            index: 6
          code:
            pattern: {type: Code, value: pharmacy}
            mustSupport: true
            index: 7
          display:
            pattern: {type: String, value: Pharmacy}
            mustSupport: true
            index: 8
        required: [display, system, code]
    required: [coding]
  created: {label: Created DateTime, short: Created DateTime, mustSupport: true, index: 19}
  insurer: {label: Insurer (masked), short: Insurer (masked), index: 20}
  priority:
    label: Processing priority
    short: Processing priority
    mustSupport: true
    index: 24
    elements:
      coding:
        mustSupport: true
        index: 25
        elements:
          system:
            pattern: {type: Uri, value: 'http://terminology.hl7.org/CodeSystem/processpriority'}
            mustSupport: true
            index: 26
          code:
            pattern: {type: Code, value: normal}
            mustSupport: true
            index: 27
          display:
            pattern: {type: String, value: Normal}
            mustSupport: true
            index: 28
        required: [display, system, code]
    required: [coding]
  status:
    label: Request status
    short: Request status
    pattern: {type: Code, value: active}
    mustSupport: true
    index: 3
  prescription: {label: Prescription (masked), short: Prescription (masked), index: 29}
  id: {label: Unique Claim Resource Identifier, short: Unique Claim Resource Identifier, mustSupport: true, index: 0}
  identifier:
    label: RTPBC request identifier
    short: RTPBC request identifier
    mustSupport: true
    index: 1
    elements:
      value: {label: Unique RTPBC request ID, short: Unique RTPBC request ID, mustSupport: true, index: 2}
    required: [value]
  provider:
    short: Preferred Pharmacy
    refers: ['http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-pharmacy-organization']
    type: Reference
    mustSupport: true
    label: Preferred Pharmacy
    index: 21
    extensions:
      preferred-pharmacy-postal-code: {url: 'http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-preferredPharmacyPostalCode', min: 0, short: Preferred Pharmacy Postal Code (Extension), type: Extension, mustSupport: true, index: 22}
    elements:
      extension:
        short: Preferred Pharmacy Postal Code (Extension)
        type: Extension
        mustSupport: true
        url: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-preferredPharmacyPostalCode
        index: 22
        slicing:
          slices:
            preferred-pharmacy-postal-code:
              match: {}
              schema: {short: Preferred Pharmacy Postal Code (Extension), type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-preferredPharmacyPostalCode', index: 22}
              min: 0
      reference: {label: Reference to Pharmacy Organization, short: Reference to Pharmacy Organization, mustSupport: true, index: 23}
  careTeam: {label: Care team information (masked), short: Care team information (masked), index: 30}
package_version: 2.0.0-ballot
class: profile
kind: resource
url: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-claim-non-phi
base: http://hl7.org/fhir/StructureDefinition/Claim
version: 2.0.0-ballot
required: [id, identifier, item]